Georgia to Charge Medicaid Beneficiaries Copayment for Prescription Drugs

To control "surging" pharmaceutical spending, Georgia has begun to charge Medicaid beneficiaries a copayment for prescription drugs that varies based on whether the drug is on a "preferred" list, the Atlanta Journal-Constitution reports. Drug expenses for the state's Medicaid program have increased about 20% per year and have contributed to recent budget shortfalls. Until July 8, the state charged Medicaid beneficiaries a copay of 50 cents for all prescriptions. Under the new policy, copays for generic and brand name drugs on the formulary are 50 cents, the current copay charged for all drugs. For brand-name drugs not on the formulary, copays range from 50 cents to $3. Nursing home patients, children and pregnant women are exempt from the copayments. State officials expect to "net significant savings" with the change, the Journal-Constitution reports. Consumer advocates, however, say the fees "can discourage patients" from buying medications. Linda Lowe, a consumer health advocate in Atlanta, said the fees "hit the poorest of the poor" and that the "copays can cause low income people to defer care in a non-emergency situation." But Lori Garner, director of pharmacy services for the state Department of Community Health, said, "We're not preventing the patient from getting the drug."

State Employee Health Plan Also Shifts
The State Health Benefit Plan, which covers 400,000 state employees, school teachers, dependents and retirees, has "shifted" to a similar copayment scale for beneficiaries in traditional health plans or preferred provider organization plans. Previously, beneficiaries paid 10% of a drug's cost after meeting a deductible. Now, beneficiaries will pay $10 for generic drugs, $20 for preferred brand name drugs and $35 to $75 for non-preferred brand name drugs. The plan will use the same formulary as the Medicaid program, the Journal-Constitution reports. State officials say the system may cost more for beneficiaries who take "several medications," but will be "less expensive" for those who use few prescriptions (Miller, Atlanta Journal-Constitution, 7/7).